Scope Of Primary Care Physicians’ Participation In The Health Insurance Marketplaces

Polsky, Daniel; Candon, Molly; Chatterjee, Paula; Chen, Xinwei

doi:10.1377/hlthaff.2018.0179

Cited by 12 publications

(19 citation statements)

References 12 publications

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“…Similar to prior work, 18,19 we found large differences across states in the size of the Medicaid and HIX physician networks offered. There was a strong correlation (ρ = 0.92) at the state level between Medicaid managed care and HIX network size.…”

Section: Conclusion and Relevancesupporting

confidence: 84%

“…Findings In this cross-sectional study of 67 057 office-based physicians in 5 states, Medicaid managed care plans included more physicians than health insurance exchange plans in the same geographic markets. Meaning These findings indicate that physicians are likelier to participate in Medicaid physician networks than previously believed, with important implications for the ongoing debate about the role of Medicaid in expanding health insurance and reforming the US health care system.Abstract (continued) suggests that Medicaid remains a viable option for expanding coverage in the United States.Similar to prior work, 18,19 we found large differences across states in the size of the Medicaid and HIX physician networks offered. There was a strong correlation (ρ = 0.92) at the state level between Medicaid managed care and HIX network size.…”

supporting

confidence: 84%

“…The data, which we linked at the National Provider Identifier level to our Medicaid network data, have been used in prior research on physician networks. [18][19][20] To determine which counties each HIX plan operates in, we used the Health Insurance Exchange Compare data set. We only included networkassociated plans that were actively marketed in 2017 on a state or federal marketplace.…”

Section: Datamentioning

confidence: 99%

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Comparison of Office-Based Physician Participation in Medicaid Managed Care and Health Insurance Exchange Plans in the Same US Geographic Markets

2020

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IMPORTANCE Several recent policy proposals have sought to expand the role of Medicaid in providing health insurance for low-income Americans, but there is little recent information on how physician participation in Medicaid compares with alternative forms of coverage for low-income Americans. OBJECTIVE To compare the number of office-based physicians included in Medicaid managed care and health insurance exchange plans that operate in the same geographic markets. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used administrative data from physician network directories and survey data from office-based physicians for Kansas, Nebraska, New York, Tennessee, and Washington. The number of participants totaled 67 057 office-based physicians in the 5 sample states. Data were collected and analyzed from May 2018 to June 2019. EXPOSURES Physician participation in a Medicaid managed care or health insurance exchange plan network. MAIN OUTCOMES AND MEASURESThe percentage of office-based physicians in a county who indicated during a phone survey that they participated in Medicaid; the percentage of office-based physicians in a county who participated in each Medicaid managed care and health insurance exchange plan network; and the percentage of office-based physicians in a county who participated in at least 1 Medicaid managed care plan or, separately, at least 1 health insurance exchange plan. RESULTSOf the 67 057 office-based physicians in our sample, 49 983 reported in a telephone survey that they accepted Medicaid. This survey-based measure undercounted the percentage of physicians participating in Medicaid by 5.2% (95% CI, 2.3%-8.1%; P < .001) relative to a measure based on physician network directories. Medicaid managed care physician networks covered a mean (SD) of 63.4% (20.5%) of office-based physicians compared with health insurance exchange physician networks, which covered 51.0% (25.2%). In adjusted analyses, Medicaid managed care plans covered 6.2% (95% CI, 3.2%-9.3%, P < .001) more office-based physicians than health insurance exchange plans operating in the same counties. In the states where the same insurers participated in both markets (New York, Tennessee, Washington), the Medicaid managed care physician networks were 6.5% (95% CI, 3.2%-9.8%, P < .001) larger than the health insurance exchange networks offered by the same insurer. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of physician network data, Medicaid managed care physician networks included more office-based physicians than the physician networks of health insurance exchange plans operating in the same geographic markets. This Key Points Question How does the percentage of office-based physicians who participate in Medicaid compare with participation in health insurance exchange plans? Findings In this cross-sectional study of 67 057 office-based physicians in 5 states, Medicaid managed care plans included more physicians than health insurance exchange plans in the same geographic markets. Meaning These findings indicate th...

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Section: Conclusion and Relevancesupporting

confidence: 84%

supporting

confidence: 84%

Section: Datamentioning

confidence: 99%

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Comparison of Office-Based Physician Participation in Medicaid Managed Care and Health Insurance Exchange Plans in the Same US Geographic Markets

2020

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“…Conversely, the closure of hospital-based obstetric services in rural counties among the United States (US) has increased rates of out-of-hospital and preterm births, and births in hospitals without obstetric units [10]. Also, the scope of primary care physicians varied a lot by health insurance schemes [11].…”

Section: Introductionmentioning

confidence: 99%

Association Between Service Scope of Primary Care Facilities and Patient Outcomes: A Retrospective Study in China

Zhong

Shi

et al. 2021

Preprint

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Background: Extending the service scope of primary care facilities (PCFs) has been widely concerned in China. However, no current data about the association between service scope of PCFs with patient outcomes are available. This study aims to investigate the association between service scope of PCFs and patient outcomes. Methods: We first sampled four counties randomly from rural Guizhou, China. Claim data of 299,633 inpatient cases covered by 64 PCFs were derived from the local information system of New Rural Cooperation Medical Scheme. The service scope of PCFs was collected with self-administrated questionnaires. Primary outcomes were 1) level of inpatient institutions, 2) length of stay, 3) per capita total health cost, 4) per capita out-of-pocket cost, 5) reimbursement ratio, 6) 30-day readmission. A total of 64 PCFs were categorized into five groups per facility-level service scope scores. Generalized linear regression models, logistic regression model, and ordered regression model were conducted to identify the association between service scope of PCFs and patient outcomes. Results: On average, the median service scope score of PCFs was 20, with wide variation across PCFs. After controlling for demographic and clinical characteristics, patients living in communities with PCFs of greatest service scope (Quintile V vs. I) tended to have smaller rates of admission by county-level hospitals (-6.2% [-6.5%, -5.9%], city-level hospitals (-1.9% [-2.0%, -1.8%]), and provincial hospitals (-2.1% [-2.2%, -2.0%]), smaller rate of 30-day readmission (-0.5% [-0.7%, -0.3%]), less total health cost (-201.8 [-257.9, -145.8]) and out-of-pocket cost (-210.2 [-237.2, -183.2]), and greater reimbursement ratio (2.3% [1.9%, 2.8%]) than their counterparts from communities with PCFs of least service scope.Conclusion: The service scope of PCFs varied a lot in rural Guizhou, China. PCFs' greater service scope was associated with a reduction in secondary and tertiary hospital admission, reduced total cost and out-of-pocket cost, and 30-day readmission and increased reimbursement ratio. These results raised concerns about access to care for patients discharged from hospitals, which suggests potential opportunities for cost savings and improvement of quality of care. However, further evidence is warranted to investigate whether extending the service scope of PCFs is cost-effective and sustainable.

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“…A distinctive trend in US health insurance is narrow networks that limit in-network services to a restricted set of clinicians and facilities. [1][2][3][4][5][6][7][8] With frequent churn occurring when patients change insurance plans, [9][10][11][12] insurance network design may have implications for the extent to which churn disrupts the continuity of care. Insurance plan changes decrease the likelihood of establishing a durable primary care relationship, decrease rates of chronic disease control, increase reliance on subspecialists for primary care services, and are associated with greater use of emergency departments.…”

Section: Introductionmentioning

confidence: 99%

Breadth and Exclusivity of Hospital and Physician Networks in US Insurance Markets

et al. 2020

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Key Points Question How does the breadth of health care networks and the degree to which they overlap vary within and across specialties and insurance markets? Findings In this cross-sectional study of 1192 health care networks, large-group employer networks were broader than small-group employer, marketplace, Medicare Advantage, and Medicaid managed care networks. In many states, narrower networks had as much, if not more, overlap across different insurers’ networks than the broadest networks; areas with less concentrated insurance, physician, and hospital markets had narrower and more exclusive networks. Meaning These findings suggest that the structure of plan networks may be a factor in determining care affordability and continuity in the United States, particularly given how frequently individuals change insurance plans.

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Scope Of Primary Care Physicians’ Participation In The Health Insurance Marketplaces

Cited by 12 publications

References 12 publications

Comparison of Office-Based Physician Participation in Medicaid Managed Care and Health Insurance Exchange Plans in the Same US Geographic Markets

Comparison of Office-Based Physician Participation in Medicaid Managed Care and Health Insurance Exchange Plans in the Same US Geographic Markets

Association Between Service Scope of Primary Care Facilities and Patient Outcomes: A Retrospective Study in China

Breadth and Exclusivity of Hospital and Physician Networks in US Insurance Markets

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